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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600404
Report Date: 07/11/2022
Date Signed: 07/11/2022 07:12:46 PM

Document Has Been Signed on 07/11/2022 07:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA SAN PEDROFACILITY NUMBER:
198600404
ADMINISTRATOR:PRESCOTT, DEEFACILITY TYPE:
775
ADDRESS:1453 W 8TH ST STE ATELEPHONE:
(310) 831-5902
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY: 25CENSUS: DATE:
07/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Latasha Bellard - Program DirectorTIME COMPLETED:
12:00 PM
NARRATIVE
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On 07/11/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Program Director Latasha Bellard and explained the purpose of today’s visit. The day program is licensed to operate for twenty-five (25) ambulatory developmentally disabled adults ages 18 and above. The consumers are Harbor Regional Center clients except for two (2) clients that are North Los Angeles.


The day program is a single-story structure located in a small business plaza. The facility consists of an administrative office, cubicles, lobby area, arts and crafts, living room with television, computer lab, meeting area, kitchen, dining/work area, conference area, lockers/storage area, storage room, and two (2) coed bathrooms.

LPA and Program Director toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected and had adequate lighting furnishings. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 115.1 F in the kitchen sink. The water temperature in the restrooms did not meet Title 22 regulations – see LIC 809D page. A comfortable temperature was maintained in the facility.

LPA observed the day program to be sanitary and appropriately supplied at the time of visit. No medications are given at the site. Sharps were stored and locked in a cabinet in Program Director's office. Cleaning supplies and toxins were in the locked storage area and not accessible to clients. The kitchen was inspected and found all appliances in working condition. There was a fire extinguisher fully charged located near the art room. LPA observed a fully stocked first aid kit in the Program Director office.

Evaluation Report Continues on LIC 809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2022 07:12 PM - It Cannot Be Edited


Created By: Don Senaha On 07/11/2022 at 11:03 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA SAN PEDRO
FACILITY NUMBER: 198600404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. The water temperature in the restroom measured 130.2 F and 137.6 F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2022
Plan of Correction
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Licensee to fix water temperature with owner of the building and report back to LPA on 7/12/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Eva M Alvarez
LICENSING EVALUATOR NAME:Don Senaha
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2022


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA SAN PEDRO
FACILITY NUMBER: 198600404
VISIT DATE: 07/11/2022
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During this visit, LPA observed the day program's infection control practices. LPA observed screening protocols for visitors, staff, and consumers, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility had a sufficient supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

There was one deficiency cited during this inspection visit. Please see LIC 809D page.

An exit interview was conducted and a copy of this report was provided to Program Director Latasha Bellard.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC809 (FAS) - (06/04)
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